Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis.
Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis.
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公共卫生危机中稀缺资源分配的操作建议。
DOI：
10.1016/j.chest.2020.09.246
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发表时间：
2021-03
期刊：
影响因子：
9.6
通讯作者：
Kachalia A
中科院分区：
文献类型：
--
作者：
Ehmann MR;Zink EK;Levin AB;Suarez JI;Belcher HME;Daugherty Biddison EL;Doberman DJ;D'Souza K;Fine DM;Garibaldi BT;Gehrie EA;Golden SH;Gurses AP;Hill PM;Hughes MT;Kahn JP;Koch CG;Marx JJ;Meisenberg BR;Natterman J;Rushton CH;Sapirstein A;Selinger SR;Stephens RS;Toner ES;Unguru Y;van Stone M;Kachalia A
2019年冠状病毒病大流行可能需要配给各种医疗资源，如果需求超过供应。资源分配的理论框架提供了急需的伦理指导，但医院仍然需要解决客观的实际情况和法律的审查，以操作稀缺的资源分配方案。为了制定针对公共卫生灾难（包括2019年冠状病毒病大流行）的可操作稀缺资源分配流程，马里兰州的五个卫生系统组成了一个联盟，该联盟具有不同的专业知识和代表性，代表了该州一半以上的医院。我们的努力建立在先前全州范围内的社区参与过程的基础上，该过程确定了公民和卫生保健专业人员在公共卫生灾难期间分配灭火器的价值观和道德参考点。通过卫生系统的伙伴关系，我们根据公民的价值观和专家的普遍共识，制定了一个稀缺资源分配框架。制定了机械呼吸机、ICU资源、血液成分、新型疗法、体外膜肺氧合和肾脏替代疗法的分配方案。为每一种资源创建操作算法提出了独特的挑战;每一种资源的不同性质和关于效益的基本数据阻止了任何单一算法的普遍适用。稀缺资源分配过程的发展必须是迭代的，经过法律审查和测试。我们提供我们的程序，以协助其他地区可能面临的挑战，配给卫生保健资源在公共卫生灾难。
The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the coronavirus disease 2019 pandemic, five health systems in Maryland formed a consortium—with diverse expertise and representation—representing more than half of all hospitals in the state. Our efforts built on a prior statewide community engagement process that determined the values and moral reference points of citizens and health-care professionals regarding the allocation of ventilators during a public health catastrophe. Through a partnership of health systems, we developed a scarce resource allocation framework informed by citizens’ values and by general expert consensus. Allocation schema for mechanical ventilators, ICU resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies were developed. Creating operational algorithms for each resource posed unique challenges; each resource’s varying nature and underlying data on benefit prevented any single algorithm from being universally applicable. The development of scarce resource allocation processes must be iterative, legally vetted, and tested. We offer our processes to assist other regions that may be faced with the challenge of rationing health-care resources during public health catastrophes.
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影响因子：
4.3
作者：
Christian, Michael D.
通讯作者：
Christian, Michael D.
DOI：
10.1073/pnas.2004064117
发表时间：
2020-04-21
影响因子：
11.1
作者：
Moghadas, Seyed M.;Shoukat, Affan;Galvani, Alison P.
通讯作者：
Galvani, Alison P.
影响因子：
120.7
作者：
Ferreira, FL;Bota, DP;Vincent, JL
通讯作者：
Vincent, JL
影响因子：
158.5
作者：
Beigel, John H.;Tomashek, Kay M.;Lane, H. Clifford
通讯作者：
Lane, H. Clifford
影响因子：
8.8
作者：
Leteurtre, Stephane;Duhamel, Alain;Leclerc, Francis
通讯作者：
Leclerc, Francis